| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
19,465 |
19,464 |
$764K |
| D0120 |
Periodic oral evaluation - established patient |
19,506 |
19,505 |
$721K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,257 |
2,826 |
$674K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,973 |
7,676 |
$461K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,252 |
3,069 |
$346K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,391 |
1,953 |
$287K |
| D1206 |
Topical application of fluoride varnish |
15,059 |
15,059 |
$272K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,582 |
2,302 |
$257K |
| D0220 |
Intraoral - periapical first radiographic image |
12,113 |
12,047 |
$216K |
| D0272 |
Bitewings - two radiographic images |
7,729 |
7,729 |
$206K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,727 |
1,040 |
$206K |
| D2140 |
|
3,322 |
2,144 |
$201K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,722 |
1,055 |
$141K |
| D0240 |
|
6,272 |
6,272 |
$138K |
| D9310 |
|
1,661 |
1,661 |
$111K |
| D1110 |
Prophylaxis - adult |
1,928 |
1,917 |
$109K |
| D0274 |
Bitewings - four radiographic images |
1,955 |
1,954 |
$104K |
| D0330 |
Panoramic radiographic image |
1,170 |
1,169 |
$101K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,839 |
4,199 |
$76K |
| D1510 |
|
227 |
201 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
1,596 |
1,560 |
$60K |
| D1351 |
Sealant - per tooth |
1,280 |
412 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,436 |
5,346 |
$45K |
| D2332 |
|
248 |
175 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
710 |
710 |
$27K |
| D2330 |
|
229 |
170 |
$17K |
| D2160 |
|
183 |
150 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
76 |
70 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
178 |
178 |
$7K |
| D2331 |
|
48 |
41 |
$5K |